Provider Demographics
NPI:1295192466
Name:HARRIS, JANET
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18757 104TH ST
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:FL
Mailing Address - Zip Code:32060-5928
Mailing Address - Country:US
Mailing Address - Phone:386-209-1446
Mailing Address - Fax:386-330-4684
Practice Address - Street 1:18757 104TH ST
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:FL
Practice Address - Zip Code:32060-5928
Practice Address - Country:US
Practice Address - Phone:386-209-1446
Practice Address - Fax:386-330-4684
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-19
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL003395000174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator